Depression and anxiety are associated with high health care utilization and mortality among adults with congenital heart disease

Benderly, Michal; Kalter‐Leibovici, Ofra; Weitzman, Dahlia; Blieden, Leonard C.; Buber, Jonathan; Dadashev, Alexander; Mazor-Dray, Efrat; Lorber, Avraham; Nir, Amiram; Yalonetsky, Sergei; Razon, Yaron; Chodick, Gabriel; Hirsch, Rafael

doi:10.1016/j.ijcard.2018.09.005

Cited by 52 publications

(39 citation statements)

References 31 publications

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“…This in accordance with a German study describing an increased prevalence of mood disorders, especially major depressive disorders, and anxiety disorders in ACHD patients when compared to the reference group . Interestingly, ASD was the most common congenital malformation among ACHD patients with depression or anxiety, and generally these patients were more likely to have a simple congenital lesion . It seems fair to assume that the size of the defects reported in these above‐mentioned studies all were large and significant, which is in contrast to the patients examined in this current study.…”

Section: Discussionsupporting

confidence: 91%

“…These data are taken as further support for the notion that cognitive and psychiatric issues in ACHD, in particular ASD, patients are a growing concern. Indeed, these issues were recently selected by a NHLBI/ACHA working group as a subject that needs to be prioritized and, subsequently, it has been reported that more than one third of ACHD patients have documentation of depression or anxiety in their medical records . This in accordance with a German study describing an increased prevalence of mood disorders, especially major depressive disorders, and anxiety disorders in ACHD patients when compared to the reference group .…”

Section: Discussionmentioning

confidence: 55%

“…Although life expectancy is improved over the last decades, patients with ASD, even if small and unrepaired, continue to have an increased mortality risk compared to the reference group . Given the fact that depression in ACHD patients is associated with worse survival prospects and increased health care utilization, it might be possible that ASD patients with depression or emotional distress have poorer late outcome than ASD patients without such complaints . Generally, depression increases the risk of death even in individuals without preexisting cardiac disease .…”

Section: Discussionmentioning

confidence: 99%

“…In sum, growing up with an ASD diagnosis, repaired or not, doubtlessly have far‐reaching consequences not just limited to somatic health problems. Supportive of this notion, a novel study concluded that ASD was the most common congenital malformation in ACHD patients associated with depression and anxiety . Given the fact that the presence of depression is associated with higher mortality in ACHD patients, it seems important to address mental health issues in patients with small ASD …”

Section: Introductionmentioning

confidence: 99%

“…Supportive of this notion, a novel study concluded that ASD was the most common congenital malformation in ACHD patients associated with depression and anxiety. 10 Given the fact that the presence of depression is associated with higher mortality in ACHD patients, it seems important to address mental health issues in patients with small ASD. 4,10 We hypothesized that a substantial proportion of patients with small, unrepaired ASD had a psychiatric diagnosis, and higher scores on self-reported psychiatric measures when compared to a reference group.…”

Section: Introductionmentioning

confidence: 99%

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Small atrial septal defects are associated with psychiatric diagnoses, emotional distress, and lower educational levels

Udholm

Nyboe

Jørgensen

et al. 2019

Congenital Heart Disease

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Objective For the first time, we wish to assess the psychiatric burden in adult patients living with small, unrepaired atrial septal defects (ASD) using register‐based data, combined with self‐reported measures on levels emotional distress and educational status. Design A descriptive study using both the unique Danish registries and validated psychiatric questionnaires and scales, including: The Symptom Checklist, Whiteley‐7, and Brief Illness Perception Questionnaire. Patients Adult patients with small, unrepaired ASD, diagnosed between 1953 and 2011. Outcome Measures Number of register‐based psychiatric diagnoses. Additionally, symptoms of anxiety, depression, somatization, health anxiety, illness perception, and levels of educational attainment compared to age‐ and gender‐matched individuals from the reference group. Results We identified 723 Danish patients with a small, unrepaired ASD. Approximately 17% of the patients eligible for inclusion had one or more psychiatric diagnoses. The most common diagnoses were neurotic, stress‐related, and somatoform disorders. A total of 140 patients (mean age 33 years) was included for examination of their mental health using psychiatric questionnaires and scales. Patients with small ASD had higher scores of depression and anxiety when compared to the reference group (0.57 ± 0.67 vs 0.39 ± 0.52; P < .001). Furthermore, patients reported more symptoms of somatization (0.51 ± 0.48 vs 0.34 ± 0.39; P < .001). Finally, a higher percentage of patients with an unrepaired ASD had no education beyond high school when compared to the reference group (33.3% vs 14.3%; P < .001) and a smaller proportion of patients had completed a short‐cycle higher education (6.5% vs 16.1%; P = .002). Conclusion Patients with a small, unrepaired ASD in adult life have more symptoms of anxiety, depression, and somatization compared to the reference group. Furthermore, fewer patients had no education beyond high school. These results support the guidelines that adults with small ASD warrants regular lifelong follow‐up in specialized clinics aware of not only adverse somatic outcome but also rates of depression and anxiety.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Small atrial septal defects are associated with psychiatric diagnoses, emotional distress, and lower educational levels

Udholm

Nyboe

Jørgensen

et al. 2019

Congenital Heart Disease

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Mediating effects of exercise capacity on the association between physical activity and health‐related quality of life among adolescents with complex congenital heart disease

Kim

Jae

Choo

et al. 2019

American J Hum Biol

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Objectives: There is little evidence on interrelationships between physical activity, sedentary behaviors, and health-related quality of life (HRQOL) among adolescents with congenital heart disease (CHD). We hypothesized that exercise capacity would have a mediating effect on the associations of either physical activity or sedentary behavior with HRQOL. Methods: Adolescents with complex CHD (n = 111) were consecutively recruited from an outpatient clinic in a general hospital in South Korea. Physical activity and sedentary behavior were assessed using the global physical activity questionnaire.Exercise capacity was directly measured by peak oxygen uptake using a symptomlimited maximal treadmill exercise test. HRQOL was evaluated by both adolescents and their parents using the Pediatric Quality of Life Inventory questionnaire. Results: The self-reported and parent proxy-reported HRQOL were positively associated with physical activity (ß = 0.16, P = .003; ß = 0.12, P = .049) and exercise capacity (ß = 0.63, P < .001; ß = 0.66, P < .001), but not with sedentary behavior in adjusted regression models. When both variables were entered in the same regression models, only exercise capacity remained significantly associated with the self-reported (ß = 0.50, P = .008) and parent proxy-reported HRQOL (ß = 0.62, P = .003). Exercise capacity acted as a full mediator variable on the relationship between physical activity and HRQOL (P < .05 for both). Conclusions: The present findings suggest that exercise capacity mediates the association between physical activity and HRQOL, highlighting the importance of improving exercise capacity to potentially enhance HRQOL in adolescents with complex CHD.

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Prevalence and predictors of psychological distress in congenital heart disease patients

et al. 2020

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ObjectiveTo determine psychological distress in congenital heart disease (CHD) patients.MethodsCross‐sectional study among consecutive CHD patients recruited from a single hospital outpatient clinic to determine anxiety and depression according to the Hospital Anxiety and Depression Scale (HADS) questionnaire.ResultsOne hundred and sixty‐nine CHD patients [29 (19–39) years old, 100 (59%) males] were studied. A total of 25% and 9% of CHD patients showed anxiety and depression symptoms, respectively. Patients with an HADS score ≥ 8 had a significantly worse New York Heart Association (NYHA) functional class, needed more psychological support, had more mental health history, and took more anxiolytic/antidepressant medication than the CHD patients with an HADS score below 8. A worse NYHA functional class [OR, 1.88 (1.01–3.52)] proved to be a predictor of a borderline/abnormal HADS score.ConclusionPsychological distress has a high prevalence among CHD patients and having an NYHA Class II and III is a significant predictor of an HADS score ≥ 8.

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Depression and anxiety are associated with high health care utilization and mortality among adults with congenital heart disease

Cited by 52 publications

References 31 publications

Small atrial septal defects are associated with psychiatric diagnoses, emotional distress, and lower educational levels

Small atrial septal defects are associated with psychiatric diagnoses, emotional distress, and lower educational levels

Mediating effects of exercise capacity on the association between physical activity and health‐related quality of life among adolescents with complex congenital heart disease

Prevalence and predictors of psychological distress in congenital heart disease patients

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